Improving Mammography Completion and Follow-Up in Community Health Centers

筛查和乳房X光检查异常后的及时随访是循证方法， 降低乳腺癌发病率和死亡率，但发病率仍然不理想。社区卫生中心 （社区卫生中心）努力解决这些问题，因为他们的能力和资金往往被 他们提供的护理量。为了减少乳腺癌的差异，我们必须扩大规模， 在这些情况下，采取有效和高效的战略来缩小筛查差距。 患者导航是一种经过充分研究的医疗服务策略，已被证明可以提高 乳腺癌筛查和异常乳房X光检查后的随访。然而， 关于CHC中导航的普遍性，能力，资金和可持续性，或者CHC如何 没有导航员使用其他人力资源来管理筛查和随访。为了解决这个问题，我们 将：（1）确定美国325个社区卫生中心使用导航仪和跟踪工具的程度; 和（2）测试是否可以进行提供跟踪功能和简短练习的低强度干预 便利化将缩小有导航仪和无导航仪的社区卫生中心的筛查差距。 我们将调查325个社区卫生中心，以收集场地特征和使用导航仪和其他 用于乳腺癌筛查和随访的人员配备模式（目标1）。这些社区卫生中心使用 通用人口管理平台，数据报告和可视化系统（DRVS）， 是由Azara Healthcare开发的，Azara Healthcare是一家专门为CHC环境提供医疗分析的供应商， 也是研究团队的亲密伙伴Azara目前正在开发新的DRVS功能， 社区卫生中心将跟踪乳腺癌筛查中的护理差距（“BC-SCR工具”），并在2020年底前部署。 我们将使用前/后测试设计来研究BC-SCR工具在两个社区卫生服务中心的使用，其中一个 导航和一个没有（目标2）。结果包括乳房X光检查的开放订单数量， 异常筛查后的随访时间。我们假设，BC-SCR工具，提供了简短的 实践便利，将改善这些结果，并缩小任何照顾之间的差距网站。虽然网站 与导航将可能受益于这些工具，网站谁使用辅助，而不是专门的，工作人员， 地址筛选可以基于在跟踪患者中提供的效率而经历进一步的益处 临床需要。研究设计提供了一个初步测试，以确定是否有必要进行更大规模的研究。 我们将使用定性方法来评估CHC工作人员的干预经验（目标3）。 该项目将首次建立和提供有关的存在，结构和稳定性的数据， 美国各地的导航系统。我们将学习如何最好地优化人力资源，并提供低- 为缩小筛选差距提供低成本、可扩展的支持。这项建议是一个及时的机会，因为它需要 本报告分析了新技术推广的优势，并观察了其在两种不同护理环境中的影响。

Screening and timely follow-up after an abnormal mammogram are evidence-based methods for reducing breast cancer morbidity and mortality, but rates remains suboptimal. Community health centers (CHCs) struggle to address these issues given that their capacity and funding is often out-stripped by the volume of care they provide. To reduce breast cancer disparities, it is essential that we scale-up strategies that are both effective and efficient to closing screening gaps in these settings. Patient Navigation is a well-studied health services strategy that has been shown to increase rates of breast cancer screening and follow-up after an abnormal mammogram. However, there is very little data about the prevalence, capacity, funding, and sustainability of navigation in CHCs, or how CHCs that do not have navigators use other staff resources to manage screening and follow-up. To address this, we will: (1) determine the extent to which navigators and tracking tools are used in 325 CHCs across the US; and (2) test whether a low-intensity intervention that provides tracking functionalities and brief practice facilitation will close screening gaps in CHCs with and without navigators. We will survey 325 CHCs to collect site characteristics and information about use of navigators and other staffing models used to address breast cancer screening and follow-up (Aim 1). These CHCs use a common population management platform, the Data Reporting and Visualization System (DRVS) which was developed by Azara Healthcare, a provider of healthcare analytics specifically for the CHC setting, and close partner of the research team. Azara is currently developing new DRVS functionalities to allow CHCs to track care gaps in breast cancer screening (“BC-SCR tools”), for deployment by late 2020. We will use a pre-/post-test design to study the use of the BC-SCR tools” in two CHCs, one with navigation and one without (Aim 2). Outcomes include number of open orders for mammography and time to follow-up after abnormal screening. We hypothesize that the BC-SCR tools, provided with brief practice facilitation, will improve these outcomes and diminish any care gaps between sites. While sites with navigation will likely benefit from these tools, sites who use ancillary, rather than dedicated, staff to address screening may experience further benefit based on efficiencies provided in tracking of patient clinical needs. The study design provides an initial test to determine if larger scale study is warranted. We will use qualitative methods to evaluate CHC staff experience with the intervention (Aim 3). This project will for the first time establish provide data about the presence, structure, and stability of navigation programs across the US. We will learn how best to optimize staff resources and provide low- cost, scalable support for closing screening gaps. This proposal is a timely opportunity in that it takes advantage of a new technology roll-out and observes its impact in two different care contexts.